Cemented Hip Arthroplasty With a Novel Cerclage
Cable Technique for Unstable Intertrochanteric
Hip Fractures
Chris Grimsrud, MD, PhD,* Raul J. Monzon, MD,y
Jonathan Richman, MD,y and Michael D. Ries, MD*
Abstract: Thirty-nine consecutive patients with unstable three and four part
intertrochanteric hip fractures were treated with cemented bipolar hip arthroplasty.
A standard length primary femoral component was used with a novel technique of
cerclage fixation of the trochanteric bone fragments allowing retention of the
femoral calcar. At one year minimum follow up, there was no loosening or
subsidence of the femoral components. All trochanters healed. One dislocation and
one deep infection occurred. Unstable three and four part hip fractures can be
treated with a standard femoral stem and cerclage cabling of the trochanters. The
technique allows safe early weight bearing on the injured hip and had a relatively
low rate of complications in our series. Key words: hip, arthroplasty, hemi-
arthroplasty, fracture, intertrochanteric, bipolar.
n 2005 Elsevier Inc. All rights reserved.
Intertrochanteric hip fractures are a major cause of
disability and death in the elderly. The incidence of
all hip fractures is approximately 80 per 100,000
persons and is expected to double over the next 50
years as the population ages [1]. Intertrochanteric
fractures make up 45% of all hip fractures. Many of
these fractures are stable two part fractures that can
be treated satisfactorily with a sliding hip screw.
However, the sliding hip screw has a higher
complication rate when used to fix unstable inter-
trochanteric fractures. Thirty-five to forty percent of
all intertrochanteric hip fractures are unstable three
and four part configurations with displacement of
the posterior-medial cortex [2,3]. The incidence of
failure when unstable intertrochanteric fractures
are fixed with a sliding hip screw averages approx-
imately 10-30% in most series [2-4]. Successful
healing of the intertrochanteric fracture with a
sliding hip screw device requires collapse at the
fracture site, which is associated with shortening of
the limb. Rotation of the lower leg may be necessary
during surgery to achieve adequate reduction of the
fracture, which can result in rotational malunion at
the fracture site. Even with successful sliding hip
screw fixation that results in healing, the shortening
and rotational malalignment of the limb that can
occur impairs hip function. Intramedullary devices
may also be used, but are associated with compli-
cations of screw migration, femoral shaft fracture
and implant failure [5,6]. Due to the instability of
these fractures, most surgeons will limit the patient
from bearing full weight on their leg after internal
fixation. However, many elderly patients who
sustain hip fractures are not capable of complying
with weight bearing restrictions during postopera-
tive ambulation.
The Journal of Arthroplasty Vol. 20 No. 3 2005
337
From the *University of California, San Francisco, and yMary
Imogene Bassett Hospital, Cooperstown, New York.
Submitted August 18, 2003; accepted May 14, 2004.
No benefits or funds were received in support of the study.
Reprint requests: Michael D. Ries, MD, Department of
Orthopaedic Surgery, 500 Parnassus Avenue (MU320-W), San
Francisco, CA 94143.
n 2005 Elsevier Inc. All rights reserved.
0883-5403/04/2003-0012$30.00/0
doi:10.1016/j.arth.2004.04.017